It's That Time of Year

It's nearing Christmas Day around here. Everywhere I go I see signs of Christmas. Trees, lights, signs, for-hire Santas walking down the sidewalks, pictures of kids oogling over their favorite toy ads, and all sorts of other visual reminders of the holiday season.

I look forward to Christmas for a couple reasons. It's to remember the birth of Christ but it also seems to bring families closer together. People give more. People tend to help out a little more. People seem to be just a little nicer than at other times during the year. Two of our kids still believe in Santa.

We watch the old Christmas cartoons I watched as a child. We make cookies on Christmas Eve and put out the reindeer food on the yard, the plate of cookies and milk by the fireplace before bedtime. It just makes things more fun.

And then there are some of the things that pop in my head at this time of year that make me sad, things I don't necessarily want to remember but I do, and they usually come up now. These are things that while sad make me very grateful for what I have around me each and every day.

I see people every day on a specific sidewalk just a couple blocks from where I work begging for money. They have no job. They have no home. They have practically nothing. I occasionally drive by a large shelter downtown and see the crowd milling about aimlessly outside waiting for the next meal, waiting for the next bed to open up so they can go lay down or just stay warm for the night.

How many people have lost a friend of family member throughout the year? They will be spending their first Christmas without that loved one, without that friend. There will be a profound emptiness in the time of families, togetherness, and love. I look at those who are working Christmas Day. I've done it countless times. I've been in foreign countries on Christmas Day and other holidays, spending it with people I work with; no family, no presents, no catching up on family gossip or eating my mom's killer apple pie.

I always think back to Christmas Day 1991 when I was working on an ambulance. Low man on the seniority list, just finished with Paramedic class. A cardiac arrest, a pediatric one, all of 6 months old just brought in to this world to experience her first Christmas. The jokes and happiness we had in the ER that morning cut short by this totally unexpected tragedy. We all worked and worked for seemingly hours doing everything we could to revive this frail little girl. Somehow, by the grace of God, we did. She was transported by helicopter to a children's hospital where she passed 3 days later. Heartbreaking, truly heartbreaking.

I cried that day. I cried because of what had happened, what I witnessed, what we all had done, and what we had achieved on that day, Christmas Day. I think of how that family lives with what happened on that day so many years ago and how their lives would and are forever changed by the events of one day, that day, Christmas Day.

But life goes on. We all do. Lest we forget those who are not here with us anymore. They will always be with us and there will always be the reminder of being with them, even if for just a short period of time. Those who have passed, those who are working, those who have nothing, and those who have everything.

There's still kindness in the world and I see it every day. There's still love in the world and I experience it every day. There will always be the hatred and cruelty that will mar what we see and blur our views, but that will go to the back of the line.

For everyone who is missing someone, for everyone who is not home with their family, for everyone who has nothing, and for everyone who has everything, be glad you have something, yourself. Merry Christmas and Happy Holidays to all.

I Love My Job!

Like most people in the EMS field, I didn't get in to this for the money. Granted, I was 17 when I began my involvement with ambulances and the love affair has grown steadily since then. I'm 40 now and I can honestly say that I love my job, I love what I do.

A lot of us quickly realized that the money just isn't easy to find in EMS so we have second and / or third jobs to help make ends meet. A lot go on to other careers but stay in healthcare. Some go on to do something completely outside of our world. But the dedicated bunch of EMTs, Paramedics, and others that remain in the EMS world, destined to be wanting more money but loving their jobs so much that they dare not leave are still here.

EMS used to be my only job. It was my first career. I loved it then, I love it now. I'd say I'm a "seasoned veteran" who's seen a lot but not everything. I've done my fair share. I've worked all around the world. I've gotten to do things most would only dream about. Yet here I am, still part of a volunteer department and loving it.

When I moved out of state I left my first EMS position behind, the place that opened up so many future doors for me. I came back after a couple years because I felt I owed it pretty much everything. I don't do it for the money, I do it for dedication and pride. I'm proud of who I am and what I've become. No, not all of my decisions have been good ones but I've learned from my mistakes. Helping others is at the forefront of what I like doing. That has transcended from the EMS world in to whatever else I do as well.

My "other life," or my real job (the one that pays the bills) is as a safety consultant on construction sites. I walked in to doing safety when I was working offshore on oil and gas drilling rigs around the world. Safety and EMS out there pretty much go hand in hand; you do something unsafe and get hurt, you go see the medic. So I fit in perfectly doing both. It's worked well for me and here I am.

It seems as though the last couple sites I've been on have somehow been tied to healthcare. I've worked at a facility that makes medicines, some of which I've either taken as a patient or given to some of my patients. Then I began a project building a new hospital. Now I'm at a site where we're building a new tower for a children's hospital. It's always been frustrating because I've started a lot of projects but have never gotten to see the end. Safety is usually one of the first positions to be removed from a site due to budget constraints. So as my sites have been completed I've only gotten to see the finished product if I've gone back on my own.



 But with the hospital project it's a little different, a little unique, and it makes me smile. I spent two years on that site, seeing it go from a hole in the ground to a nearly finished facility, one that will specialize in cardiac care. I've gotten to know the hierarchy of the hospital very well. I know the building like the back of my hand. I hold a vested interest in it because I will be taking my cardiac patients there. It'll be a true definitive care facility for those patients I pick up.

What's special is that I will be working there as an employee in the ED. I even asked the manager if i could work the first shift that the facility is open. She told me that I've "earned it," and that it was mine. I beamed with excitement after hearing that. Finally I get to see a facility I worked on, helped build, and will be a future customer of. Now I get to be there and see how everything we all toiled on for so long will work.

As I wait for that one to open up and to begin working there I've been moved to another location. This time it's a more special place. One of those places that makes me tear up when I see certain reminders or hear certain catch phrases about the place. I'm at a children's hospital, building a new tower for kids who so desperately need to be here. This is one of those places that nobody wishes was needed but everyone is thankful that it is, just because of the special things that happen here,the miracles that happen daily, the lives that are saved because of the awesome people and care that the sick kids around here can receive. This is one of only 250 childrens' hospitals in the US. That's not too many if you stop and think about it. Only 250 facilities to take care of our sick and injured children, nieces, nephews, and grandkids.

I did an informal "Hank Poll" the other day and approached 42 people working here out of roughly 175. Every single one of them either knows or is related to someone who has had a child or relative treated here. I'm one of them. This facility is part of a large network and my youngest has been here a couple dozen times. Close friends of mine have had their kids here. People I work with have been here or had their kids here. And everyone has come out better and healthier.

I walk around here daily just smiling knowing that I'm part of building a new tower that will help children, help them heal and get better, be a comfortable inviting place for parents to bring their sick kids to be treated and hopefully back home very shortly after. I see the stuffed animals on the banister in the lobby and smile. I can remember #3 saying, "daddy, I want one of those!" and pointing to one of the big lions. I see kids being pulled around in red wooden wagons instead of wheelchairs. I see kids smiling in the family areas with IV poles next to them as they color in books with their parents. I see adults sharing french fries from McDonald's with their kids in the lounge areas outside the lobby by the cafeteria. I see and hear kids playing together upstairs in the patient rooms with their siblings.

I've called this building, "the best place in the world." I'm proud to be a part of it. I honestly hope I never have to bring one of my kids here ever again. I would like to see a place like this never be needed by anyone, but I'm damn happy that it is here in case it is needed by anyone, including me, to help sick and injured kids from not just here but anywhere in the world.

Places like this with me a small part of it, make me honestly say, "I love my job."

Drives Me Nuts...

A toothache at 2am.

An earache at 430am.

Drunk drivers who hurt or kill other people when they're perfectly fine, other than the obvious fact that they're brains are switched "OFF."

Yep, ambulance runs. There's plenty more where that came from.

"Take me to _____ Hospital. I have my 'card' and you have to take me."

People who meet you outside their house with a packed suitcase in hand, ready to go.

"Can't get this damn splinter outta my hand."

"Oh, this ain't no big deal cher. I've had me 8 babies already. This one will be awright. Jes tired uh bein' damn pregunant like."

"Ain't gonna go there. They's some mean peoples there. Take me to ______ (60 miles away). They knows me theyuh (smiles with a toothless grin)."

A girl's first period with her mother right next to her. Would have thought the world was coming to an end.

Sore throat. Seriously? A damn sore throat???

Out of medication and there's plenty of free medicine at the hospitals.

"My momma's already theyuh and I wants to go see huh. Can y'all take me theyuh?"

"My hair hurts."

Big boogers that just can't be removed.

Bugs in ears.

People who get return trips to hospitals still wearing the gowns they came home with a month prior; and it looks like they haven't been washed or taken off that entire month.

Oxygenated patients who smoke, still smoke, or are presently smoking in my presence with oxygen on.

Patients who have to have a smoke before they go to the hospital. Sorry, I wait for no KOOL.

People who swear at me, not with me.

Assholes. Cocky.

Other healthcare providers who critique how I'm handling them or their family.

Healthcare providers who are on scene first and do the complete wrong thing for the patient's welfare.

Family members who just won't shut the hell up and let the patient speak for themself.

Police who don't help out when asked.

People who just won't help themselves. They don't care, don't give a shit, or whatever. If you don't, why should I?

Lastly (for now), people in EMS who don't have the passion, drive, compassion, to be there day after day helping others who truly need our skills and expertise. If you don't like it or want to be there, leave. You drag the rest of us down. 23 years in to my young EMS career and I still love it.

Hangin' It Up

I've always been told that healthcare providers are the worst patients. I agree. We know too much. We self treat. We self diagnose. We're never wrong. We're never sick. We know more than most doctors. I usually tell my patients, as I'm sticking them, that it's odd that I have to hurt them to make them feel better. I also tell patients that medicine is called a "practice" because it's just that; it's NOT an exact science.

I've wondered, more often recently than before, about the future. What will I do? Will I keep in the healthcare field? How long is too long? Am I burned out? Have I had enough? Do I still love it, have the passion for it, want to educate and impart my experiences to others?

Things now aren't what they used to be. Instead of people bossing me around and telling me what to do I'm kind of in that seat now. Our generation is taking over from another one and we're molding the next generation to take over from us. It's kind of neat to see people I grew up with running things, owning businesses, making money and having families and doing all the things we watched our parents do.

I am a picky person. I don't settle for second best. I know what I like and that's it. I don't accept change very easily unless I can see benefit and immediate results from it. I used to act first and think second but now I've changed that. I try to take my time and make informed decisions and calls before I pass judgment on someone or something. I try to not let biases get in my way.

I, like most, get fed up with the system. I get tired of hearing bullshit complaints from nurses, doctors, hospitals, or patients about something we did supposedly wrong. It takes my time and energy away from doing my job to investigate things and back my staff up. It's a pain. First off, are they not accountable? Why am I getting the call and not them? Well, I am in the head chair so it is kinda my job. But hearing bullshit complaints and dealing with petty issues that need to be resolved elsewhere grows old.

Another issue I have is taking care of kids. Pediatric patients have always been tough no matter the situation. Having kids of my own makes it even tougher. I picture any pediatric patient I have as being one of my own. Can i give them the same treatment, the same compassion and care that I would if they were my own? Sure I could but I wouldn't want one of my kids to need my skills and knowledge. I would never want to stick a needle in my child's arm or immobilize them after a wreck or put them in a splint because they fell and broke their leg. I'd hate that. It hurts even now to see my kids get so upset when they get booster shots. I can see and hear the terror in their eyes and cries yet it's for their own healthy well-being.

I know I can't always make things right. I can't always kiss the oowies and make them go away. A hug doesn't work all the time or a rub on the head, a scratch of the back. Those times hurt when I can't make the pain go away, for my kids or someone else's.

You know, I've never, in 23+ years had an adult call that's bothered me. From my first cardiac arrest to being puked on to my first evisceration. I've seen a lot but not everything. The only run that still, to this day, bothers me is a pediatric one. I don't remember the name but I can remember all the minute details of who, when, where, what happened, almost regurgitate it from beginning to end. Almost 21 years ago that happened and I can remember it so vividly.

I see people who have been doing this for years and they get burned out. They lose their drive for helping others. I haven't gotten to that point but dealing with all the bullshit is old. I get tired of the lack of respect, the not getting answers, the accountability or lack thereof people tend to have.

I've contemplated for the last year of slowly letting myself out of this realm. I don't think I'm ready. The younger generation is up and coming and eager to step in to our shoes and push us to the back of the class as they assume their positions in front. I'm almost ready to see it happen but I have a little more left. For now, I'm where I'm at. If you don't like it then I say, "tough shit." Come at me with respect and desire and I'll help you get whatever you want. Come at me with disdain and laziness and I'll boot your ass out the door. I've earned the respect of my peers and I expect it to be shown to me as I'll show it back with eagerness.

If It Wasn't Documented, It Didn't Happen

Many times in my EMS and professional career I've come across that phrase. It's been said to me, I've told it to others, I've overhead others having conversations about it.

For the sue happy world documentation has to be one of the best defenses we can have. I stress upon people all the time that we need to document the most minute details in some of these cases. A lot of areas are going to check boxes and things like that that reduce or eliminate narrative sections. Several years ago when I worked elsewhere they looked at doing that, thereby eliminating what the EMT or EMT-P wrote. Check boxes are simple, quick, and easy but leave a lot to be desired. Of course there are those calls that can easily be documented by ticking a box. But not all.

People have asked me, "have you ever been called to court or been deposed?" Yes I have and it's no fun. I've had runsheets or PCRs torn apart because I misspelled a word, forgot a minute detail, misquoted what the patient said, forgot to get a signature, or didn't use the preferred widely accepted abbreviation.

I'm a firm believer of, "if it wasn't documented, it didn't happen or it wasn't done." I'm in the midst of a suit that happened 2 1/2 years ago. I explained to the lawyer that I was raised writing everything down; what I saw, what I heard, what was said to me, what the scene and surroundings are. If those things are pertinent to the patient, the outcome, or for future reference they need to be written down. I told her that I typically write novels for PCRs because I want to make sure I cover my ass as well as my service's. I don't want anyone to get in trouble because of something I did or didn't do and failed to document.

Crime scenes are especially vulnerable to being called to court. Drunk driving accidents or any car accident is likely to be called to court. Workman's comp cases and jobsite injuries are very common ones where someone sues later for a settlement.

I've seen 4 and 5 sentence paragraphs for an ALS dyspneic patient and I've seen 2 and 3 pages for BLS car wrecks. The people writing them vary as do their styles and the ways they were trained. Their mentors and preceptors may have done different things in their documentation. I tell people to make their own variation of different people to adequately suit their cause and develop their own style. I used to get criticized for taking so long on my reports but I was able to stick it back to my employer the first time I got called to court and had my usually long narrative with me. It allowed me to remember that particular incident 3 years post.

Discussed with some people last week about SORs and their need. Those too are cya things. Ran in to a situation recently where someone didn't want any c-spine or lsb after we'd already placed it on at their request. I asked the patient if they'd be willing to sign an SOR or AMA form releasing us of any liability before it was removed. The response? A quiet, "no." So we went about our job or helping the patient out. There were some special details that needed to be in the documentation but it was needed to help cover us, show what we faced, how we handled it, what we said, what we knew needed to be done yet were not allowed to because of the patient's wishes.

How often do people actually document that a steering wheel was bent? Which direction? Was there damage to the interior of a car? How far did the door protrude in? Which airbags deployed? Did anyone notice the multiple pill bottles on the sink next to the 10 empty alcohol bottles? Ever mentioned about the odor or smell of the inside of the house? Was it pertinent to the problem at hand? What did the patient tell you? Be specific. Quote exactly. What we write on are legal documents and can come back to be your best friend in court,... or they can haunt you.

There are also things like irate parents and family members who spout off things that don't need to be documented but need to be addressed or passed on. Case in point would be a parent who is spouting off everything from the time you walk in to the door to the time you drop off the patient in the ED. But in that brief moment the patient is away from the parent the story changes, the details come out; your treatment may easily be swayed by what you see AND hear from the patient them self. Most people can speak for themselves. Give them the opportunity if you can as it's for their benefit (obviously). I usually try to bring the nurse or staff out of the room / area and discuss things with them so I'm not corrected, told I'm wrong, or make situations worse by that family member. And make sure you document whatever's pertinent.

If it wasn't documented, it didn't happen.

End of Life Miracles. Awesome!

I’m sitting in one of the most uncomfortable chairs ever made by mankind. Hospital furniture is unforgiving at best and hell on spines, backs, arms, legs, every possible bone in the body that comes in contact with them.

“It is a dark and stormy night,…” actually it is. There’s a tornado watch out for our area until 3a and it’s only 1148p. The big stuff has already rolled through with just some lingering showers still remaining in the line, at least what I see on the radar on my phone.


Room 624 is a rather noisy place. About 3 feet to my left is my wife, trying but failing at sleeping on a roll-away bed and her mother is next to her in another. The nurses up here brought them in here last night when they stayed in here to keep an eye on the room’s patient.


6 feet in front of me lies my father-in-law, all of 73 years young. He’s got a PICC line in his left arm. Hooked up to that is a maintenance line of .9NS, a PCA pump with morphine running TKO @ 2mg / hr and 1 mg boluses q 10 min. He’s on 15 lpm via a partial non-rebreather mask and hooked up to an oxygen “oximiser” which is basically a high pressure / high flow humidified oxygen device. He’s got that hooked to a nasal cannula at 30 lpm. The noise of the high flow oxygen is almost deafening but it’s doing its job.


Pulmonary fibrosis is sapping the life out of Bill, my father-in-law; one of the best men I’ve ever known, ever will know, and an all around fantastic father, papaw, and man. Hard working, educated, sentimental, sensitive, no bullshit kinda guy he is; always has been and still is today. Even with all this he still has a wicked sense of humor.


He was diagnosed with PF about 8 months ago and began using oxygen at home PRN. Then it went to constant use @ 2 lpm, then 4, then 6. A week ago he developed pneumonia which sapped things quicker. The docs told us he had 3 – 6 months to live. After the pneumonia kicked in and really began whipping his ass the docs told us it was down to a couple weeks, if that. The digression in status continued rather quickly from there and still does.


But what this is about, other than the background history, is what I’ve seen, what we’ve seen in the last two days. I can’t explain it, it defies logic, it’s almost miraculous. I don’t think dad will ever go home from here and twice in the last two days I, we thought it was the end. He’s still here and let me tell you about it.


Dad’s a recovering alcoholic and scotch was his drink of choice. Hasn’t had the stuff in a decade since he’d stopped. Went to AA and treatment and got dry. Best move he ever made. He’s slowly been making requests for things and getting affairs tidied up since he accepted the end is near. Three days ago he said he’d like to have a shot of Johnnie Walker, the “best stuff they make.” He’d never had it and I knew it was JW Blue. I’d seen it in duty free shops all around the world. Damned expensive so I never bought any.


I called around to at least 14 area liquor stores and none had it. Went to another half dozen and the same. So I went to work yesterday morning and made a couple calls to find a bottle somewhere, anywhere, regardless of cost. He was worth it and I’d travel if I had to. He’d paid his dues and it was his wish to have that one last luxury of life and I was making damned sure he got it. I made the call to the fourth place in Indianapolis and I asked the clerk if he had a bottle of it. “I have one bottle and that’s it.” My eyes lit up and my hands grabbed for a pen to write down directions. I told the man to guard it with his life, pull it off the shelf, hide it somewhere that nobody else could see it; this was the last request of a dying man who so richly deserved this taste of excellence.


I left work and hurried down the road to get it. It was only 10a and the clerk seemed more happy than I was to sell it to me since I told him what it was for. I paid for it, snuggled it safely in the crook of my arm like a newborn baby, smiled from ear to ear, and hurried to my truck to deliver the fantastic present.


Throughout the day Bill had been declining in status. Sats were in the low to mid 70s, pulse in the 110 – 120 range, doing a lot of belly breathing and moaning, and had us all wondering how long he could work so hard to get his next breath.


I left that afternoon to go pick up our kids to bring them to see papaw. I went to the barn to do some work and forgot my cell phone in the kitchen. #2 went to the house and came running back to the barn carrying my phone. “Daddy, someone’s been calling you. Your phone’s been going crazy!” I saw 12 missed calls, 9 text messages, and 7 voice mails in the last 15 minutes. My wife was frantic, telling me he was about gone, taking his last breaths, and he was asking where I was, that he wanted to see me, “my son,” and his wife. I grabbed the kids and rushed to the hospital in my truck.


I was met by a friend of my wife who’s also a nurse. She met me at the elevator with tears streaming down both cheeks, the corners of her mouth turned downward in a sad frown, and she said, “The end’s almost here. Hurry up and get in there.” I left our kids with her and walked inside. The minister was there as was Bill’s wife, me, my wife, my sister-in-law, and Bill’s brother-in-law. We said a nice prayer, all told him we loved him and that everything would be all right. We were all teary eyed and some crying, knowing the end was in sight. “It’s all right to go. Everything will be fine. Don’t worry about mom, we’ll take care of her. We’ve got everything under control so there’s no need to worry. Rest and relax and go if you want. We love you, we all love you.”


I looked around and said, “I think it’s time we do this before it’s too late.” I walked to the other side of the room to the closet where I’d hidden my smuggled bottle of Johnnie Walker Blue Label and put it on the counter. I pulled out a couple shot glasses I grabbed form home and poured 4 shots out. I gave one a shot glass to Bill, one daughter, his brother-in-law, and one for me. We made a toast to family and love and downed our shot. Damn, that was some smooth stuff; worth every penny. I’m not a scotch drinker but that stuff was wonderful! Dad's response? "Man! That's goooooood" with a wide smile and twinkling eyes.


Now for the good part.


In about 30 – 45 minutes after that shot Bill was talking normally. Even though he was still wearing a non-rebreather he wasn’t gasping for air. His pulse dropped to below 100. His sats climbed in to the mid 90s. He was visibly relaxed and breathing wonderfully. I grabbed the ears off of the RT and he was clear. No wheezes, no congestion / rales / crackles, nothing. We were talking like normal. We began talking about family, old times, work, making jokes and laughing; it was comical. We had gone from doom and gloom to laughing and cracking up. The scene reminded me of the movie “Awakenings” when the patients “come back to life” from their frozen Parkinsonian states. It was a miracle! It was neat as hell. It was something that I couldn’t explain. This 180 degree turnaround could only be attributed to a shot of scotch! For the next 4 hours it was like this. Simply fantastic; unexplainable but fantastic. Wow! Even the minister commented that he “now believed in the power of Johnnie Walker Blue Label.” We all cracked up on that one, even dad.


After about 4 hours things began going south again. I likened it to patients I’ve had before who had a fantastic turnaround for a short time before the end crash. Seen it happen before and I thought this was that too.


Through the night things steadily got worse. During the next day things continued downhill to the point of putting on the high pressure oxygen and adding a PCA pump. He was working hard, harder than before. Coughing came more frequent with blood tinged sputum. He was tired. He said he was and we all knew it. It couldn’t be much longer.


I went home to get our kids again and bring them up. When I got here I was met by my brother-in-law who brought in Bill’s other two grandkids. We all went up to the room and the boo hoos began again. It was a repeat but worse of yesterday afternoon. We all said a big prayer and were hugging, crying, and saying our “goodbyes” all over again. I looked at my brother-in-law who knew the story of the day before’s events and said, “Let’s do another round and call it ‘the Final Shot Round 2.’ “ He smiled and agreed. All of the immediate close family was present. All the grandkids and relatives who were close and tight knit gathered around the bed. I poured 7 shots, enough for every adult present. We said another toast as I asked dad to offer it. He passed that honor to me. “Family” was all I could muster out between sobs and caught breaths. Dad finished it with “love and togetherness always.” We all clinked our shot glasses and plastic cups and downed our Blue Label again.


And it happened again. In about 30 minutes the breathing eased, the sats skyrocketed to 98, 99, 100%, the coughing ceased. The speaking was easy but slightly labored. But the conversation came again. The jokes, the stories, the laughs, anything and everything. Twice in two days. Another day, another brief miracle of a couple hours to spend with this fantastic man just talking and living as normal, even if we were in a hospital room. The kids were eating popsicles courtesy of a floor tech, we sat and talked and joked as the kids played. Dad even removed his NRB so he could talk easier and hear better as we all talked, seemingly at once. It was fantastic. The emotional roller coaster had made another stop in his room yet again.


So now it’s after midnight and he’s lying on his right side, moaning with each breath. The belly breathing has resumed again, the PCA pump still running in its medication. The RT just gave him a nebulizer treatment, shortly before his nurse gave him some haldol to relax him so he could sleep a little. He’s struggling for each breath. I know he’s worn out and tired. He’s worked harder in the last couple months than he has all of his life. This damned disease is sucking the life out of Bill, the man who has to be the best father-in-law a person could ever ask for. A friend, a mentor, a papaw, a gentleman, protector, and just all around fantastic person to everyone he met.


But we all got to see not one but two huge rallies. Unexplainable by any means. I’ve seen it once but never expected twice. I still can’t figure it out and I don’t want to try. I just want to remember these two “awakenings” as they happened. The love, laughter, conversation we all had for those 3 or 4 hour windows was truly fantastic. I still shake my head and smile about it.


We’ll try it again later today if we get the chance. If not I’ve already decided to take the rest of the bottle and do a toast graveside with all of us who witnessed those rallies. It’ll be a fitting tribute to this man, this terrific man, father, and friend to us all. The bottle will go with him, one way or another. It’s his bottle, not mine.


But for now life is again quickly fading away in room 624. I’ll miss you Bill, dad, pal. At least not just me but everyone got to smile and talk with you these last two afternoons like nothing was wrong. It was terrific. It was fantastic. It was a miracle that happened not once but twice. I know the end is near but those extra precious moments we had were just, how to say it and give it justice, were awesome. I’ll always smile when I think about it.


My eyes are welling up as I finish this as he struggles 6 feet from me to breathe. But I’m also smiling knowing what I know, seeing what we all saw, and enjoying those last moments. Take a break. You’ve earned it. You deserve it. Rest and relax. I’ll miss you dad, thank you for everything. I love you.


Love,

Your son-in-law

Death and Dying

Dealing with death is never easy on either side of the fence. I guess I’m lucky in that I’ve not lost too many close relatives or friends. About a week before Thanksgiving in 2004 I lost my gramma, a woman I miss every single day. She was my pal, my confidant, my mentor, everything. She took care of me and I tried to take care of her in return.


She’s the closest relative I’ve ever lost.


In the business of EMS we deal with death frequently. Mind you, it’s not necessarily every single day or shift but in some settings that may be the case. In our small area we see some but not often. We have some from old age, from overdoses, from car wrecks, from other means. We aren’t a homicide mecca around here but we do have one or two a year.


Some of these deaths come from homes. Others come from a retirement home or community, others an ECF, highways, roadways, or even one of our three local prisons. We get the gamut from everywhere. Some old, some young, some too little to walk or talk.


Each person deals with death and dying in their own way. Each has their release. Each handles the scene or the people in their own way. The first time I did CPR on someone I was 17 and she was in her mid 90s. No problem. The first child I did was in the middle of the school day and she was 13. To this day her mother puts a memorial in the local paper on her birthday so I am reminded of it every year. The first infant death I had was Christmas Day 1991. All three of those times I was asked if I was okay, if I needed to talk to someone, if I was handling things all right. Each time I had no problem. I got upset, I cried on one, I still think about all three as they’re still fresh in my mind even all those years ago.

I’ve dealt with screaming family members, fights by bystanders who were like warring factions, loud noises and distractions from roads, fires, a little bit of everything. Most every time I’ve had to, in some way, deal with the family. Some of those times it’s been “pleasant,” if you will, while other times it’s been a nightmare. More so now than in the past I try to make sure the family is addressed by someone else if not by me. They’re a part of my scene and my patient and they need to be dealt with too. They may need a shoulder to cry on as nobody else is there. They may be too distraught to call anyone. They, like us, deal with death and dying in their own ways that may not mimic the way we do. “Normal” people don’t see death as often as we do nor do they deal with it in the ways we do. They have an attachment to our patients where normally we do not. We may not know them. In a small area like ours we may well know the person or a friend of family of the patient. Usually around here most deaths touch someone on our service in some way, close or distant.

We aren’t nurses who see these patients for an entire 12 hour shift or weeks or months in an ECF and get to know them. We don’t get to know their quirks, their personalities, the way the smiled or looked at someone. We normally don’t know their families and if they were visited or abandoned. We see them for a short time, carry them to the hospital or simply wait for the coroner or local funeral home to come and collect the body.

Some people are in denial. Some people cry hysterically. Some people pass it off as, “it was their time.” Everyone’s different. The one big thing I try to do other than deal with or make sure the family is dealt with is keeping some form of dignity with the patient. If they’re pronounced on the scene we need to let them keep their dignity. I’ve seen scenes before where all the clothes have been ripped off, the crew pronounces them, then leaves the immediate area while others are milling around this now naked dead body. Dignified? Professional? No. If I were a family member and saw that I’d want someone’s head. I’d try to have someone’s job. I wouldn’t treat someone like that and I damn sure don’t want my family treated that way.

I’ve also seen providers lose sight of the picture because they have an attachment to the patient and not provided standard care. Happened? Yep. Understandable? Yep. That’s where the others need to step in and help out, get them aside and let proper care happen.

Probably all SOPs or protocols address DNRs, advanced directives, or living wills. At times the family forgets where they are. They may change their mind at the last minute and want everything done. They may not want anything done yet the patient DID want something done. I’ve seen it all. It’s hard to comfort a patient’s family as we’re pounding on their chests, sticking needles all over the place and pushing all sorts of drugs and putting tubes here, there, and everywhere. We’re working hard in an effort to save people. We don’t always succeed but we give it our best shot.

Medical professionals deal with death. But when it’s us who’s on the other side it’s the same as above. We now become those who may be hysterical, crying, upset, screaming and hollering, lose sight of what’s best for the patient, anything at all. When it’s our loved one everything we know and have been taught kinda goes out the window as it’s now our crisis, our family member, our loss; not someone else’s that we need to console their family. We want someone to console us, to give us a shoulder to cry on, a door to punch, something to help ease the loss of our close family member right in front of our faces.

Remember that we see one side of death and dying. We’re not usually on the other side. If you ever are, God forbid, and experience that loss please remember how you were treated, what you felt, the profound sense of loss and emptiness you feel or felt. The next time you have a patient that dies on you or you are called to work on and you’re around their friends or family, remember those things. Remember what you craved and needed during your event. Remember those things and try to make them feel better, more comfortable; be empathetic. Keep the patient’s dignity intact and help the family all you can. It may be staying on scene to talk to the family, making calls for them, waiting until someone else shows up.

It could be you in that scene. How would you want to be treated? Death and dying is never easy, for anyone. Keep those things in mind and let your best judgment and conscience be your guide.

Change,.. for the better?

Think back when you first got in to EMS. What type of equipment did you have? What was the quality? Were they things you thought would be around forever? Were they techniques that were the "latest and greatest" only to be superseded in 5 years? What about personalities, traits, and qualities of our people? How about our patients?

Used to use a Datascope and LP5. Now we're up to a LP12 or LP15. 12 leads in the field, capnography, pulse oximetry, all that from one monitor. Used to be everything separate and HUGE.

Two man cots were the norm. What a pain! The amount of back injuries had to have been astounding during those days. Saw one a couple weeks ago and thought of how long ago it was when I used one. Then the one man cots came out with the Teflon runners. Still a pain to put in a bus. Now we have electric cots. Nicer to maneuver around but the added weight may be a concern for some. I think ours is about 27 lbs heavier than our old ones.

The old gumball lights on a truck's exterior used to be "it." Now a vehicle can be "Griswolded" up with LEDs. Man, what a difference! Sirens also have made neat changes. The old "Q" to the Rumbler, which I think is neat. I do like how a lot of departments have a Q on their vehicles in keeping with tradition or just because it's always been a reliable warning device.

AEDs have progressed mightily. They've been out since 1979. We got our first one in 1989 for $12,500 and it was the size of a large carry-on luggage bag. Had a nice screen to see the rhythm and it was damn heavy. Now ours are about the size of a big laptop and cost around $1400. The new ones can be "automatic" and do seemingly everything for you. Long battery shelf life, lighter, smaller, cheaper.

@IRLMedic mentioned BSI. Holy cow! Didn't it used to be a sign of a busy or "good" shift because of the amount of blood you had on your uniform? It was for me! Never brought another uniform to work if one got dirty. Nah, it just showed the other crews how busy I had been. Gloves? Safety glasses? CO detectors and monitors? I gripe at new EMTs and our rookies if I see them without gloves on, regardless of who the patient is. I'm not the best example but I also do a good job of keeping clean and not getting anything on me.

We are lucky enough to have received a grant for a Glidescope. It's a terrific tool that, in my eyes, is making intubation a lost art form. I love the fact that it helps keep our faces away from a patient's face in case of unexpected showers of vomit and other nasties and that it gives us a great color picture of what we're after. Expensive, yes. In a couple years the cost will probably be cut in half.

Our CPR changes have been rolled out this year. Seems like every couple years there's a change or two in store for us. This year they remove drugs and have even less emphasis on respirations. Used to be hyperventilation was good and airways were paramount. We could push drugs through an ET! Now if we can't get them tubed and no peripheral line we just put in an IO. With BIGs and EZ IOs IV problems are seemingly a thing of the past. IOs didn't used to be thought of in adults, just kids. Now they're becoming more and more standard first attempt on certain situations for time's sake.

We used to treat HTN in the field. We used to give a lot of bicarb, calcium and mag. Some of the other meds I used to carry were Brethine, Lanoxin, Mannitol, Decadron, nitro paste, among others. I think I'd be hard pressed to find those on a bus now with short transport times, if at all. MAST pants were the norm; Sager splints and build-a-boards; steel O2 cylinders. Just a year or so ago I got rid of an old bicycle pump suction unit I had in my supply closet. I remember when V-Vacs first came out and they were lauded because of the way they could suck up a can of Chunky soup in no time flat. Remember the old blue laptop case looking suction units that never seemed to have enough power to suck anything?

So, what's next? What else can be improved on? I'm trying to think of different ways things will be improved in the next year, 5, or 10 years. I'm amazed as I look back and see all the technological changes I've witnessed, how treatment modalities have changed, and how everything in EMS continues to evolve in to a new form of medicine, rife with technology and knowledge, fueled by exuberance, dedication, and longevity.

EMS will always be around and we will continue to change with it as it changes. How will you accept the changes we make?

Anonymous BS

Thought for a while what to title this and couldn't think of a good one. So the "Anonymous BS" stuck out as keeping some anonymity along with the amount of BS involved.

We as pre-hospital professionals are just that; professionals. It's not to say that everyone is on the same level or on par with everyone else. Different places teach different things, instructors vary, personalities differ, and skill levels are obviously different. But we all know the basics.

What about issues when dealing with staff at sending or receiving facilities? Everyone has their favorite, so to speak, on both sides of the coin. It's nice for me to walk in to an ER and know the tech or nurse I'm talking to. If the doc's handy and not busy and I know him or her I'll go shoot the bull for a couple minutes. And I'm sure it's just as nice for the staff to know the crew bringing in or taking away patients; they know the person performing the care, maybe their skill sets, how long they've been around, are truly compassionate, those sort of things.

What drives me nuts is not being listened to when I take a patient somewhere. I spit out information on the radio or phone before I get there, and again when I get there and most of what I say isn't taken down or in. Granted, it doesn't happen often but it does happen. We are a vital link in transferring and providing care to those patients. We see them in uncontrolled environments, see their first actions or reactions to treatments, and try to improve the situation and report on how things have progressed or digressed.

Another issue is the lack of proper care some people receive prior to our arrival. Several times I've shown up on accident scenes and am met by someone who identifies themself as a nurse. Okay,... are you an ER nurse? Do you know anything about pre-hospital or trauma? Several times these same people are the ones who have removed patients from cars or trucks and had them walk around the vehicle and then lay down when they should have stayed where they were in the car; they were in NO danger and should not have been moved. Do they know about holding c-spine? Did they do a primary assessment? Mind you, I'm not slamming the nursing profession but not many nurses know a lot about pre-hospital or have been through a PHTLS, ACLS, or PALS / NPR course unless it's required for their job.

What about trips to ECFs? Ever shown up to find a patient with a nasal cannula at 10 lpm? What about a non-rebreather at 4 lpm? How about CPR being done on a bed without a short board and watching those bed springs get one hell of a workout. Ever seen that? Seizure patients being held down with beds, chairs, carts right next ot them. Another one I've seen is giving cola or orange juice to an IDDM who's now hypoglycemic and completely unresponsive. The word "aspiration" comes to mind pretty quickly.

I've been to a lot of ECFs around the country and it's just like any medical facility; there's the good staff, and there's the bad staff. Same goes for pre-hospital; we have good EMTs and Paramedics and we have our bad lot as well.

One thing I've always tried to do is educate people I see who are doing something wrong, regardless where they're at. If I see a cannula on too high a setting I'll say something. If I hear of a wrong medication given to someone I'll say something or question it. I have the right to question anything I feel is incorrect because my concern is for the patient, not for the staff taking care of the patient. The same thing applies to the staff questioning what we do. We know things they don't and they know things we don't. Some of these patients have drug stores on speed dial because their med list is a mile long. Do I know every one? Nope. Hopefully the staff does and they can tell me when, how much, actions / reactions, whatever's pertinent.

They give report to me just like I give report back to them on return or to another when I drop someone off somewhere else. It has to be communicated thoroughly and completely.

We all have to deal with the BS on every side, from receiving to transferring, emergent to transfer. It's how we deal with that BS that makes a difference in how we handle the situation and continue to treat our patients the best we possibly can.

All Shifts Are Not Created Equal

Strengths and weaknesses; we all have them and we all know everyone else does too. Some people flaunt theirs and other do what they can to hide them. Some are out in the open for all to see while others are deep-seeded and difficult to find. There are still others who hold on with the faintest of hopes that they’ll eek by and never get caught with their pants down and those who think they are God’s gift to mankind.

Look at our field, EMS. Do we have those people, I mean both extremes? Do you know any? Do you work with any? I’ll bet that everyone says that they do to both counts.

So the next batch of questions come in; what have you done about it? Have you said anything to a superior? To that person? Have you tried to eliminate the problem or help it? Are you trying to be proactive in your approach with the patients' interests at heart or are your hands tied?

I went through EMT class when I was 17 and a senior in high school. I passed my written and practicals before I turned 18. It took me about a year before I felt truly comfortable with my knowledge and skill base. At that time I felt that I could handle anything thrown in front of me. I loved being an EMT. I was aggressive. I wanted calls that would challenge my skills. Seems normal, right? I got in to Paramedic school when I was 19 and finished when I was shy of my 21st birthday. It too took me about a year or so to feel truly comfortable with my skills as a Paramedic.

It wasn’t long after I got out of Paramedic school that I began to realize I wanted to see things done “my way.” It was the correct way, or so I thought, and that everyone else should be doing it that way. On one hand I like helping and teaching others how to do things, imparting my knowledge to them (hadn’t gotten all the experience just yet). I liked teaching others. I liked precepting EMT and Paramedic students. Here I was only 21 and already doing that. I wanted to do my part in helping others succeed at good patient care. Then as the years crept by I got more in to educating and making sure that others did things the right way; not necessarily “my” way, but the proper way.

Everywhere I’ll go I always run across some who seemingly have no clue. Their hearts are in the right place and they like being a part of something like EMS but if put out on their own in a busy, not necessarily messy, cardiac arrest or multi-systems trauma that they soon would be overtaxed. These are the people who would either freeze on the spot or would be so focused on one thing that they overlook the obvious which could be detrimental to the patient’s outcome.

Have I been there? Yep. So have a lot of people and they should have no problem admitting it. I haven’t seen everything but I’ve seen and done a lot. I have learned to slow down and take a look at the overall picture of a scene, regardless what it is, prior to moving forward. For example, on car wrecks I’ll always look at the outside of the vehicle first so I know what kind of damage has been done before I look inside at the patient and the interior compartment. I know there’s always urgency but not to the point of overlooking things.

So, what do we do about these “weaker” people? Do we discard them? Do we put them on shift with someone who will carry them? Do we keep them as warm bodies in cold seats? Do we educate them in hopes of rehabilitating them in to productive members of our EMS crews?

Usually these “weak" people are easily identified. They usually hang back and are the followers, not the leaders. They do not direct. They seem pensive. They may be terrific “hands” on a scene but if placed by themselves they will not function adequately or at a substandard rate. Mind you, I understand that not everyone is suited to be a "leader" and that's perfectly fine. But often the people who need the help, need the experience, get pushed aside by the leaders of the pack, the more aggressive ones who want to make sure things get done. There are times when that's needed but others when things can be slowed down to allow them to be a part of the call, do some skills, have a hand in direct patient care, and be let to feel more comfortable with their surroundings and skills as we the leaders watch from an arm's length and are there to jump in at any given moment if things go south.

How do we handle them? How can we? More times than not they’re placed with partners or shifts that can absorb their skills in to their own and they become that needed set of hands to do work, not necessarily the thinkers on the call. The “weaker” ones are placed with the “stronger” ones to balance out in hopes that they may, by course of osmosis, absorb the necessary skills and knowledge to be productive, to function normally like most others do, to properly and adequately care for the patient and protect themselves and the crew at the same time. Big tasks to be asked of all, all at once, and handled by a group that routinely do each and every day without a bat of an eye.

I’ve found that bringing inadequacies to some people offends them. It makes them feel inferior like saying, “you suck at being an EMT,” when they probably humped it to get through class. Do it tactfully. Offer suggestions. More and more I’m critiquing runs after the fact with the crews not only because I have to do internal a & r but because it helps everyone in a smaller group discuss what they saw, what they did, what part they took in the call, and ask / answer questions. If a single person has a problem or I saw something that wasn’t right I’ll ask that person on the side what they saw, what they did, what they thought of the run, and then offer constructive criticism.

Find out what their weaknesses are, if possible. Is it knowledge? Is it skills? It might be something as simple as letting them "get their hands dirty" on a call. They may not feel comfortable doing some skills or handling a particular piece of equipment. It might be that a certain type of call intimidates them or scares them.

I’m not the smartest Paramedic out there as I learn things all the time, even after 23+ years in EMS. I still miss subtle signs. I too focus in on one thing and miss the obvious. It’s happened to all of us at one time or another.

If you see someone who has problems or questions things, help them out. Don’t let their questions go unanswered. The longer they linger the longer they may go and not properly treat a patient because they’re afraid of doing the wrong thing. In the end they’ll leave EMS because they feel inadequate and that they don’t know how to help people. Answer questions. Ask questions. Practice with these people, with crews; do training the right way and don’t make a pencil exercise out of it. Talking about things and actually putting your hands on are two completely different things. They’re not the same. Hopefully with help, education, perseverance, and determination by both sides these “weak” people will become the stronger ones and help the next batch of “weak” people.

Listen, learn, educate, and help. Such a vicious cycle but we’ve all been there before.